Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions

doi:10.13105/wjma.v11.i6.290

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World Journal of Meta-Analysis

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Meta-Analysis

World J Meta-Anal. Sep 18, 2023; 11(6): 290-312
Published online Sep 18, 2023. doi: 10.13105/wjma.v11.i6.290

Table 1 Details of the 10 studies of acute myocardial infarction

Study ID^a	Ref.	Country	Design	Study population	Start year	Yr followed	Age	Sex^b	Cases	Adjust^c	Excl^d	Latency^e	Endpoint	NRR^f
BIOBANK	[37]	United Kingdom	Cohort	National	2006	12	40-69	M, F	5081	2	0	0	Diagnosed	2
CaCHS	[38]	Canada	Cohort	Regional	2001	13	20+	M, F	1133	15	0	0	Diagnosed	2
CALIBER	[39]	United Kingdom	Cohort	GP records	1997	13	30+	F	5628	1	0	0	Diagnosed	1
EPIC-GERM	[40]	Germany	Cohort	Regional	1994	14	35-65	C	507	0, 9	0	0	Diagnosed	2
ESTONGENOME	[41]	Estonia	Cohort	National	2002	13	18+	M, F	118	0, 1	0	0	Died	4^g
KIHD	[42]	Finland	Cohort	Regional	1984	18	42-60	M	205	0	0	0	Diagnosed	1
TROMSO	[43]	Norway	Cohort	Regional	1979	33	20-94	F	854	0, 4	0	0	Diagnosed	2
VASTERBOTTEN	[44]	Sweden	Cohort	Regional	1990	19	30-60	C	2062	2, 9	0	0	Diagnosed	2
WHILA	[45]	Sweden	Cohort	Regional	1995	20	50-59	F	205	1, 7	0	0	Diagnosed	2
WHS	[46]	United States	Cohort	National	1992	26	45+	F	629	0, 14	0	0	Diagnosed	2

^aStudy IDs are BIOBANK: The UK Biobank Study; CaCHS: Canadian Community Health Survey; CALIBER: Cardiovascular disease research using linked bespoke studies and electronic health records; EPIC-GERM: European Prospective Investigation into Cancer and Nutrition, German component; ESTON-GENOME: Estonian Genome Center of the University of Tartu; KIHD: Kuopio Ischemic Heart Disease Risk Factor Study; TROMSO: Tromsø Study; VASTERBOTTEN: Västerbotten Intervention Programme; WHILA: Women’s Health in the Lund Area Study; WHS: Women’s Health Study.

^bC: Results only for sexes combined.

^cNumber of adjustment factors for which relative risk (RR) available (0: Unadjusted, 1: Age adjusted, N > 1: Adjusted for N factors).

^dNo study had results available for exclusive use.

^eNo study excluded deaths in the early period of follow-up.

^fNumber of RRs available.

^gSome of the RRs used from this study came from personal communication from Professor Koks.

Table 2 Details of the 23 studies of ischaemic heart disease

Study ID^a	Ref.	Country	Design	Study population	Start year	Yr followed	Age^b	Sex^c	Cases^d	Adjust^e	Excl^f	Latency^g	Endpoint	NRR^h
7CNTRY-ITALY	[47]	Italy	Cohort	Regional	1960	50	40-59	M	319	3	0	0	Died	1
ARIC	[48]	United States	Cohort	National	1987	30	45-64	C	1798	0, 15	0	0	Diagnosed	2
BIOBANK	[49]	United Kingdom	Cohort	National	2006	12	40-69	C	547	0	0	0	Diagnosed	1
CALIBER	[39]	United Kingdom	Cohort	GP records	1997	13	30+	F	16800	1	0	0	Diagnosed	1
CPS-II	[50]	United States	Cohort	National	1982	22	30+	C	13478	0, 23	0	0	Died	2
CoCHS	[51]	Denmark	Cohort	Regional	1991	22	20-93	F	900	1	0	0	Diagnosed	1
ELSA	[52]	United Kingdom	Cohort	National	2004	13	52+	C	352	0, 7	0	0	Diagnosed	2
EPIC-10	[53]	Multi	Cohort	International	1991	19	35-70	M, F	7198	0	0	0	Diagnosed	2
	[54]	Multi	Nested CC	International	1991	19	35-70	C	7198	0	0	0	Diagnosed	1
EPIC-UK	[55]	United Kingdom	Cohort	Regional	1993	14	45-79	C	2332	0, 2, 6	0	0	Diagnosed	3
ESTON-GENOME	[41]	Estonia	Cohort	National	2002	13	18+	M, F	696	0, 1	0	0	Died	4ⁱ
FINRISK	[56]	Finland	Cohort	National	1982	25	25-74	F	NR	3, 8	0	0	Died	2
HAPIEE	[57]	Multi	Cohort	International	2002	9	NAR	C	225	0	0	0	Died	1
HSE-SHS	[58]	United Kingdom	Cohort	National	1994	17	NAR	C	1412	0, 7	0	0	Died	2
JACC	[59]	Japan	Cohort	Regional	1988	21	40-79	M, F	1554	0, 7, 9	x	0	Died	4
MALMO	[60]	Sweden	Cohort	Regional	1991	22	46-67	M, F	3217	0, 6	0	0	Diagnosed	4
MESA	[61]	United States	Cohort	Regional	2000	11	45-84	C	449	1, 14	0	0	Diagnosed	3
	[62]	United States	Cohort	Regional	2000	11	45-84	C	449	0	0	0	Diagnosed	1
NAS	[63]	United States	Cohort	Regional	1991	20	NAR	F	137	0	0	0	Diagnosed	1
NHS	[64]	United States	Cohort	Medical workers	1989	17	43-68	F	3874	0	0	0	Diagnosed	1
NHS-II	[65]	United States	Cohort	Medical workers	1991	20	25-42	F	456	1, 15	0	0	Diagnosed	2
PREVEND	[66]	Netherlands	Cohort	Regional	2001	9	32-80	C	212	0, 2, 10	0	0	Diagnosed	3
USA5	[67]	United States	Cohort	Regional	2000	11	55+	M, F	29931	0, 5	0	0	Died	4
WHI	[68]	United States	Cohort	National	1993	20	50-79	F	2975	11	0	0	Died	1
WHITEHALL	[69]	United Kingdom	Cohort	Civil servants	1967	43	40-69	M	3250	1	0	0	Died	1

^aStudy IDs are 7CNTRY-ITALY: Italian Rural Areas of the Seven Countries Study; ARIC: Atherosclerosis Risk in Communities Study; BIOBANK: The UK Biobank Study; CALIBER: Cardiovascular disease research using linked bespoke studies and electronic health records; CPS-II: Cancer Prevention Study 2; CoCHS: The Copenhagen City Heart Study; ELSA: The English Longitudinal Study of Ageing; EPIC-10: European Prospective Investigation Into Cancer and Nutrition; EPIC-UK: The European Prospective Investigation of Cancer -Norfolk; ESTON-GENOME: Estonian Genome Center of the University of Tartu; FINRISK: The National FINRISK Study; HAPIEE: Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) project; HSE-SHS: Health Survey for England and the Scottish Health Survey; JACC: Japanese Collaborative Cohort Study; MALMO: Malmö Diet and Cancer Study; MESA: Multi-Ethnic Study of Atherosclerosis; NAS: Normative Aging Study; NHS: Nurses’ Health Study I; NHS-II: Nurses’ Health Study II; PREVEND: Prevention of Renal and Vascular End-Stage Disease; USA5: Cancer Prevention Study II Nutrition, Nurses’ Health Study I Women’s Health Initiative cohort, National Institutes of Health–AARP Diet and Health Study, and Health Professionals Follow-up Study; WHI: Women’s Health Initiative; WHITEHALL: The Whitehall Study.

^bNAR: No age restriction specified.

^cC: Results only for sexes combined.

^dNR: Not reported.

^eNumber of adjustment factors for which relative risk (RR) available (0 = unadjusted, 1 = age adjusted, N>1 = adjusted for N factors).

^fx: Results available for exclusive use.

^gNo study excluded deaths in the early period of follow-up.

^hNumber of RRs available.

ⁱSome of the RRs used from this study came from personal communication from Professor Koks.

Table 3 Details of the 31 studies of stroke

Study ID^a	Ref.	Country	Design	Study population	Start year	Yr followed	Age^b	Sex^c	Cases	Adjust^d	Excl^e	Latency^f	Endpoint	NRR^g
7CNTRY-ITALY	[47]	Italy	Cohort	Regional	1960	50	40-59	M	225	3	0	0	Died	1
ARIC	[48]	USA	Cohort	National	1987	30	45-64	C	1106	0, 14	0	0	Diagnosed	2
BIOBANK	[70]	UK	Cohort	National	2006	12	40-69	M, F	4662	2	0	0	Diagnosed	2
CALIBER	[39]	UK	Cohort	GP records	1997	13	30+	F	11842	1	0	0	Diagnosed	1
CPS-II	[50]	USA	Cohort	National	1982	22	30+	C	5582	0, 23	0	0	Died	2
CaCHS	[38]	Canada	Cohort	Regional	2001	13	20+	M, F	1636	15	0	0	Diagnosed	2
	[71]	Canada	Cohort	Regional	2001	11	20+	M, F	1636	0	0	0	Diagnosed	2
ELSA	[52]	UK	Cohort	National	2004	13	52+	C	326	0, 7	0	0	Diagnosed	2
EPIC-10	[54]	Multi	Nested CC	International	1991	19	35-70	C	2187	0	0	0	Diagnosed	1
EPIC-ITALY	[72]	Italy	Cohort	Regional	1993	15	35-74	M, F	386	0, 2, 10	0	0	Diagnosed	6
EPIC-SPAIN	[73]	Spain	Cohort	Regional	1992	16	29-69	F	301	0	0	0	Diagnosed	1
EPIC-UK	[55]	UK	Cohort	Regional	1993	14	45-79	C	385	0, 2, 6	0	0	Diagnosed	3
ESTON-GENOME	[41]	Estonia	Cohort	National	2002	13	18+	M, F	156	0, 1	0	0	Died	4^h
HAPIEE	[57]	Multi	Cohort	International	2002	9	NAR	C	109	0	0	0	Died	1
HSE-SHS	[58]	UK	Cohort	National	1994	17	NAR	C	690	0, 7	0	0	Died	2
JACC	[59]	Japan	Cohort	Regional	1988	21	40-79	M, F	3163	0, 7, 9	x	0	Died	4
JHS	[74]	USA	Cohort	Regional	2000	15	21-84	C	183	0, 11	0	0	Diagnosed	2
JP8	[75]	Japan	Cohort	National	1983	30	40+	M	3487	0	0	0	Died	1
MALMO	[76]	Sweden	Cohort	Regional	1991	22	46-67	C	305	0	0	0	Diagnosed	1
MESA	[62]	United States	Cohort	Regional	2000	11	45-84	C	180	0	0	0	Diagnosed	1
MILLION	[28]	United Kingdom	Cohort	National	1996	19	46-66	F	8103	8	0	0	Diagnosed	1
NFBC	[77]	Finland	Cohort	Regional	1966	49	14-46	C	352	0, 10	0	0	Diagnosed	2
NHIS	[78]	United States	Cohort	National	1987	24	18-95	C	2046	0, 5	x	0	Died	2
	[79]	United States	Cohort	National	1987	14	18-95	C	2046	0, 8, 9	0	x	Died	3
	[80]	United States	Cohort	National	1987	28	40-79	M	2046	0, 1, 9	0	x	Died	3
NHS	[64]	United States	Cohort	Medical workers	1989	17	43-68	F	3288	0	0	0	Diagnosed	1
NIH-AARP	[81]	United States	Cohort	Regional	2004	7	70+	C	1369	0, 4	0	0	Died	2
NLMS	[82]	United States	Cohort	National	1985	26	35-80	C	3083	0, 1, 5	x	0	Died	3
OHASAMA	[83]	Japan	Cohort	Regional	1998	12	60+	C	293	2	x	0	Diagnosed	1
PREVEND	[66]	Netherlands	Cohort	Regional	2001	9	32-80	C	83	0, 2, 10	0	0	Diagnosed	3
SCCS	[84]	United States	Cohort	Regional	2002	11	40-79	C	389	7	0	0	Died	1
USA5	[67]	United States	Cohort	Regional	2000	11	55+	M, F	9821	0, 5	0	0	Died	4
WHITEHALL	[69]	United Kingdom	Cohort	Civil servants	1967	43	40-69	M	1061	1	0	0	Diagnosed	1
WHS	[46]	United States	Cohort	National	1992	26	45+	F	887	0, 14	0	0	Diagnosed	2

^aStudy IDs are 7CNTRY-ITALY: Italian Rural Areas of the Seven Countries Study; ARIC: Atherosclerosis Risk in Communities Study; BIOBANK: The UK Biobank Study; CALIBER: cardiovascular disease research using linked bespoke studies and electronic health records; CPS-II: Cancer Prevention Study 2; CaCHS: Canadian Community Health Survey; ELSA: The English Longitudinal Study of Ageing; EPIC-10: European Prospective Investigation into Cancer and Nutrition; EPIC-ITALY: Italian European Investigation into Cancer and Nutrition; EPIC-SPAIN: Spanish European Investigation into Cancer and Nutrition; EPIC-UK: The European Prospective Investigation of Cancer -Norfolk; ESTON-GENOME: Estonian Genome Center of the University of Tartu; HAPIEE: Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) project; HSE-SHS: Health Survey for England and the Scottish Health Survey; JACC: Japanese Collaborative Cohort Study; JHS: Jackson Heart Study; JP8: Pooled analysis of eight prospective studies in Japan; MALMO: Malmö Diet and Cancer Study; MESA: Multi-Ethnic Study of Atherosclerosis; MILLION: Million Women Study; NFBC: Northern Finland Birth Cohort; NHIS: National Health Interview Survey; NHS: Nurses’ Health Study; NIH-AARP: National Institutes of Health–AARP Diet and Health Study; NLMS: National Longitudinal Mortality Study; OHASAMA: The Ohasama Study; PREVEND: Prevention of Renal and Vascular End-Stage Disease; SCCS: Southern Community Cohort Study; USA5: Cancer Prevention Study II Nutrition, Nurses’ Health Study I, Women’s Health Initiative cohort, National Institutes of Health–AARP Diet and Health Study, and Health Professionals Follow-up Study; WHITEHALL: The Whitehall Study, and WHS: Women’s Health Study.

^bNAR: No age restriction specified.

^cC: Results only for sexes combined.

^dNumber of adjustment factors for which relative risk (RR) available (0 = unadjusted, 1 = age adjusted, N>1 = adjusted for N factors).

^ex: Results available for exclusive use.

^fx: Results available with deaths excluded in early period of follow-up.

^gNumber of RRs available.

^hSome of the RRs used from this study came from personal communication from Professor Koks.

Table 4 Acute myocardial infarction and current vs never cigarette smoking – results from random effects meta-analyses

Full output table	Factor	Level	No. of RRs	No. of studies	RR (95%CI)	Test of heterogeneity by level (NS = P ≥ 0.1) and trend if relevant, P value
	All		13	10	2.72 (2.40-3.08)	< 0.001
5	Sex	Combined	2	2	2.98 (2.20-4.04)
		Males	4	4	2.30 (1.57-3.37)
		Females	7	7	2.83 (2.40-3.34)	NS
6	Region	N. America	3	2	3.42 (2.93-3.99)
		Europe	10	8	2.54 (2.22-2.90)	< 0.01
7	Study population	National	5	3	2.85 (2.16-3.77)
		Regional	7	6	2.69 (2.18-3.33)
		Other	1	1	2.51 (2.33-2.71)	NS
8	Year of start of baseline	< 1988	2	2	1.81 (1.28-2.56)
		1988+	11	8	2.93 (2.58-3.32)	< 0.05
9	Number of cases	< 1000	7	6	2.52 (1.96-3.25)
		1000+	6	4	2.87 (2.46-3.35)	NS
10	Lowest age considered	< 30	5	3	3.02 (2.09-4.35)
		30-44	6	5	2.58 (2.20-3.04)
		45+	2	2	2.88 (2.40-3.46)	NS trend NS
11	Yr of follow-up	10-< 20	10	7	2.78 (2.40-3.23)
		20-< 30	2	2	2.88 (2.40-3.46)
		30+	1	1	2.11 (1.81-2.46)	< 0.05 trend < 0.01
12	Endpoint	Died	2	1	2.99 (1.34-6.67)
		Diagnosed	11	9	2.71 (2.38-3.08)	NS
13	Number of adjustment factors	None	1	1	1.47 (1.08-2.01)
		Age only	3	2	2.52 (2.34-2.71)
		More	9	7	2.89 (2.48-3.37)	< 0.001
14	Disease definition standard	No	6	7	2.43 (2.06-2.87)
		Yes	7	5	3.14 (2.63-3.74)	< 0.05

Table 5 Ischaemic heart disease and current vs never cigarette smoking – results from random effects meta-analyses

Full output table	Factor	Level	No. of RRs	No. of studies	RR (95%CI)	Test of heterogeneity by level (NS = P ≥ 0.1) and trend if relevant, P value
	All		28	23	2.01 (1.84-2.21)	< 0.001
19	Sex	Combined	10	10	1.94 (1.71-2.21)
		Males	7	7	1.86 (1.53-2.26)
		Females	11	11	2.23 (1.86-2.69)	NS
20	Region	N. America	9	8	2.23 (1.92-2.58)
		Europe	17	14	1.90 (1.67-2.15)
		Japan	2	1	2.15 (1.73-2.69)	NS
21	Study population	National	9	8	2.10 (1.92-2.30)
		Regional	12	9	1.85 (1.56-2.19)
		Other	7	6	2.18 (1.77-2.69)	NS
22	Year of start of baseline	< 1988	5	5	1.89 (1.56-2.27)
		1988+	23	18	2.04 (1.83-2.28)	NS
23	Number of cases	< 1000	12	11	1.97 (1.58-2.45)
		1000+	16	12	2.04 (1.83-2.27)	NS
24	Exclusive cigarettes	No	26	22	2.00 (1.82-2.21)
		Yes	2	1	2.15 (1.73-2.69)	NS
25, 26	Lowest age considered	< 30	5	4	2.45 (1.77-3.39)
		30-44	11	9	1.81 (1.61-2.05)
		45+	9	7	2.06 (1.76-2.42)	NS trend without missing NS
		Missing	3	3	2.09 (1.16-3.78)
27	Yr of follow-up	< 10	2	2	2.52 (1.07-5.90)
		10-< 20	13	10	2.04 (1.77-2.35)
		20-< 30	10	8	1.99 (1.78-2.23)
		30+	3	3	1.68 (1.23-2.29)	NS trend NS
28	Endpoint	Died	13	10	2.23 (1.94-2.57)
28		Diagnosed	15	13	1.83 (1.62-2.05)	< 0.05
29	Number of adjustment factors	None	6	5	2.11 (1.78-2.50)
		Age only	5	4	1.64 (1.39-1.93)
		More	17	14	2.10 (1.88-2.35)	< 0.05
30	Disease definition standard	No	13	12	1.83 (1.59-2.10)
30		Yes	15	11	2.17 (1.93-2.45)	< 0.1

Table 6 Stroke and current vs never cigarette smoking – results from random effects meta-analyses

Full output table	Factor	Level	No. of RRs	No. of Studies	RR (95%CI)	Test of heterogeneity by level (NS = P ≥ 0.1) and trend if relevant, P value
	All		37	31	1.62 (1.48-1.77)	< 0.001
35	Sex	Combined	17	17	1.65 (1.52-1.50)
		Males	9	9	1.48 (1.21-1.80)
		Females	11	11	1.66 (1.39-1.99)	NS
36	Region	N. America	14	12	1.64 (1.48-1.83)
		Europe	19	16	1.71 (1.51-1.94)
		Japan	4	3	1.18 (1.04-1.34)	< 0.001
37	Study population	National	13	11	1.76 (1.47-2.11)
		Regional	19	15	1.55 (1.36-1.78)
		Other	5	5	1.51 (1.39-1.65)	N.S.
38	Yr of start of baseline	< 1988	8	8	1.43 (1.23-1.67)
		1988+	29	23	1.68 (1.52-1.85)	< 0.1
39	Number of cases	< 1000	18	16	1.66 (1.44-1.91)
		1000+	19	15	1.59 (1.41-1.78)	NS
40	Exclusive cigarettes	No	32	27	1.67 (1.52-1.84)
		Yes	5	4	1.31 (1.19-1.45)	< 0.001
41, 42	Lowest age considered	< 36	8	6	1.59 (1.19-2.14)
		30-44	16	13	1.48 (1.35-1.62)
		45+	11	10	1.89 (1.68-2.12)	< 0.01 trend without missing < 0.01
		Missing	2	2	1.87 (1.54-2.28)
43	Yr of follow-up	< 10	3	3	2.13 (1.80-2.53)
		10-< 20	22	17	1.69 (1.52-1.89)
		20-< 30	7	6	1.43 (1.29-1.60)
		30+	5	5	1.44 (1.10-1.89)	< 0.001 trend < 0.001
44	Endpoint	Died	16	13	1.60 (1.41-1.81)
		Diagnosed	21	18	1.63 (1.46-1.83)	NS
45	Number of adjustment factors	None	7	7	1.32 (1.08-1.62)
		Age only	4	3	1.70 (1.31-2.20)
		More	26	21	1.69 (1.53-1.88)	< 0.1
46	Disease definition standard	No	20	18	1.68 (1.51-1.88)
		Yes	17	13	1.55 (1.36-1.77)	NS

Table 7 Comparison of meta-analysis relative risks for ischaemic heart disease in this study and in other publications

Ref.	Region	What is smoked	Comparison group^a	RR (95%CI) males	RR (95%CI) females	RR (95%CI) any
Woodward et al[17], 2005	Asia-Pacific	Cigarettes	Non	1.56 (1.44-1.70)	1.73 (1.50-2.01)	1.60 (1.49-1.72)
Woodward et al[18], 2005	Asia, Australia, New Zealand	Cigarettes	Non			1.86 (1.69-2.06)
Nakamura et al[16], 2009	Asia	Undefined	Never			1.97 (1.66-2.33)
Huxley et al[19], 2011	Any	Cigarettes	Non	1.72 (1.57-1.88)	1.92 (1.66-2.23)	1.79 (1.61-1.98)
Mons et al[15], 2015	Any	Undefined	Never	1.80 (1.51-2.15)	2.26 (1.98-2.59)	2.03 (1.63-2.54)^b
Lee et al[5], 2017^c	North America, Europe, Asia	Cigarettes^d	Never	1.99 (1.81-2.19)	2.12 (1.87-2.40)	2.05 (1.90-2.21)
Colpani et al[13], 2018	Any	Cigarettes^e	Never		3.12 (2.15-4.52)
Hackshaw et al[14], 2018	Any	20 cigarettes per day	Never	2.04 (1.86-2.24)	2.84 (2.21-3.64)	2.34 (1.96-2.79)
Lee et al[11], 2018^c	Japan	Cigarettes^d	Never	1.98 (1.74-2.25)	2.59 (2.06-3.27)	2.21 (1.96-2.50)
This meta-analysis	North America, Europe, Japan	Cigarettes	Never	1.86 (1.53-2.26)	2.23 (1.86-2.69)	2.01 (1.84-2.21)

^aFormer smokers are included among nonsmokers, but are not included among never smokers.

^bEstimated from data provided.

^cIncludes results for coronary heart disease and acute myocardial infarction.

^dIncludes results for any product if those for cigarettes not available.

^eAssumed to be cigarettes as study in women.

Table 8 Comparison of meta-analysis relative risks for stroke in this study and in other publications

Ref.	Region	What is smoked	Comparison group^a	RR (95%CI) males	RR (95%CI) females	RR (95%CI) any
Woodward et al[17], 2005	Asia-Pacific	Cigarettes	Non	1.29 (1.20-1.38)	1.42 (1.26-1.62)	1.32 (1.24-1.40)
Nakamura et al[16], 2009	Asia	Undefined	Never			1.34 (1.12-1.48)
Peters et al[22], 2013	Any	Cigarettes	Non	1.67 (1.49-1.88)	1.83 (1.58-2.12)	1.73 (1.58-1.89)
Chen et al[20], 2014	Western	Cigarettes	Never			2.27 (1.76-2.93)
Mons et al[15], 2015	Any	Undefined	Never	1.44 (1.23-1.68)	1.78 (1.46-2.17)	1.59 (1.29-1.95)^b
Lee et al[5], 2017	North America, Europe, Asia	Cigarettes^c	Never	1.42 (1.29-1.56)	1.54 (1.33-1.78)	1.48 (1.37-1.60)
Wang et al[23], 2017	China	Undefined	Undefined			1.53 (1.06-2.20)^b
Colpani et al[13], 2018	Any	Cigarettes^d	Never		2.09 (1.51-2.89)
Hackshaw et al[14], 2018	Any	20 cigarettes per day	Never	1.64 (1.48-1.82)	2.16 (1.69-2.75)	1.90 (1.54-2.35)
Lee et al[11], 2018	Japan	Cigarettes^c	Never	1.32 (1.16-1.51)	1.50 (1.16-1.94)	1.40 (1.25-1.57)
Pan et al[21], 2019	Any	Cigarettes^c	Never^e	1.54 (1.11-2.13)	1.88 (1.45-2.44)	1.92 (1.49-2.48)
This meta-analysis	North America, Europe, Japan	Cigarettes	Never	1.48 (1.21-1.80)	1.66 (1.39-1.99)	1.62 (1.48-1.77)

^aFormer smokers are included among non smokers, but are not included among never smokers.

^bEstimated from data provided.

^cIncludes results for any product if those for cigarettes not available.

^dAssumed to be cigarettes as study in women.

^eSex-specific relative risks (RRs) are compared to non-smokers.

Citation: Lee PN, Coombs KJ, Hamling JS. Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions. World J Meta-Anal 2023; 11(6): 290-312
URL: https://www.wjgnet.com/2308-3840/full/v11/i6/290.htm
DOI: https://dx.doi.org/10.13105/wjma.v11.i6.290